The Association Between Cumulative Periodontal Disease and Stroke History in Older Adults

BACKGROUND

Since the late 1980s, several studies have been conducted to investigate the relationship between periodontal disease and ischemic stroke. The purpose of this study is to investigate the relationship of periodontal disease to the self-reported history of stroke in the elderly (60 years of age and older) by examining the data of the Third National Health and Nutrition Examination Survey (NHANES III).

METHODS

Data from NHANES III, a large population-based cross-sectional survey of the United States, were used for this study. Because 1,563 of the 5,123 subjects in the study were edentulous, and periodontal disease is a major cause of tooth loss, it was necessary to account for edentulousness in the statistical analysis to avoid bias. Hence, a new index called the periodontal health status (PHS) index was developed to address this problem. Two measures of PHS were developed: PHS I, based on the median percentage of sites with >/=2 mm clinical attachment loss (CAL), and PHS II, based on the median percentage of sites with >/=3 mm CAL. Multiple logistic regression analysis was used to test for the association of PHS with stroke history. Two types of a multiple logistic regression model were fit: 1) logistic regression modeling with adjustment for age and tobacco use only; and 2) logistic regression modeling with adjustment of all statistically significant confounders.

RESULTS

Based on multiple logistic regression analysis of PHS with adjustment for age and tobacco use only, completely edentulous elderly adults (PHS Class 5) and partially edentulous (teeth in one arch) elderly adults with appreciable clinical attachment loss (PHS Class 4) were significantly more likely to have a history of stroke compared to dentate adults (teeth in both arches) without appreciable clinical attachment loss (PHS Class 1). When multiple logistic regression models were fit with adjustment of all significant confounders, no statistically significant association was found between PHS and stroke.

CONCLUSIONS

Based on the results of this study, there is evidence of an association between cumulative periodontal disease, based on PHS, and a history of stroke. However, it is unclear whether cumulative periodontal disease is an independent risk factor for stroke or a risk marker for the disease.

Risk of tooth loss after cigarette smoking cessation

INTRODUCTION

Little is known about the effect of cigarette smoking cessation on risk of tooth loss. We examined how risk of tooth loss changed with longer periods of smoking abstinence in a prospective study of oral health in men.

METHODS

Research subjects were 789 men who participated in the Veterans Administration Dental Longitudinal Study from 1968 to 2004. Tooth status and smoking status were determined at examinations performed every 3 years, for a maximum follow-up time of 35 years. Risk of tooth loss subsequent to smoking cessation was assessed sequentially at 1-year intervals with multivariate proportional hazards regression models. Men who never smoked cigarettes, cigars, or pipes formed the reference group. Hazard ratios were adjusted for age, education, total pack-years of cigarette exposure, frequency of brushing, and use of floss.

RESULTS

The hazard ratio for tooth loss was 2.1 (95% confidence interval [CI], 1.5-3.1) among men who smoked cigarettes during all or part of follow-up. Risk of tooth loss among men who quit smoking declined as time after smoking cessation increased, from 2.0 (95% CI, 1.4-2.9) after 1 year of abstinence to 1.0 (95% CI, 0.5-2.2) after 15 years of abstinence. The risk remained significantly elevated for the first 9 years of abstinence but eventually dropped to the level of men who never smoked after 13 or more years.

CONCLUSION

These results indicate that smoking cessation is beneficial for tooth retention, but long-term abstinence is required to reduce the risk to the level of people who have never smoked.

Compliance as a prognostic indicator: retrospective study of 505 patients treated and maintained for 15 years

BACKGROUND

The relationship of patient compliance to overall tooth prognosis remains controversial. There are little data, often conflicting, that pertain to tooth loss as a function of patient compliance.

METHODS

This retrospective study evaluates the impact of compliance (complete versus erratic) on common periodontal clinical variables, such as probing depth, bleeding index, plaque index, and tooth loss for 505 patients in a long-term period of observation (15 to 23 years) and maintenance therapy (at least 10 years). Compliance was defined in two ways for all analyses. Under the definition for compliance 1, patients who missed <30% of all prescribed maintenance visits were classified as complete compliers. Under the definition for compliance 2, patients who never went 2 years without a maintenance visit were classified as complete compliers. Change in clinical variables was dichotomized into reduction in plaque index versus no reduction, reduction in bleeding on probing versus no reduction, reduction in the percentage of periodontal pockets>3 mm versus no reduction, no increase in decayed, missing, or filled teeth (DMFT) versus increase, and no tooth loss versus tooth loss. The effects of both definitions of compliance were then evaluated in a series of multiple logistic regression models with adjustment for potential confounders.

RESULTS

The analysis of the dichotomous change in clinical parameters over time revealed that complete compliers tended to show reduction in bleeding on probing and reduction in plaque index compared to erratic compliers for both definitions of compliance. In contrast, complete compliers under compliance 2 were less likely to have a reduction in the percentage of periodontal pockets >3 mm compared to erratic compliers, whereas complete compliers under compliance 1 had about the same likelihood of demonstrating a reduction in periodontal pockets compared to erratic compliers under this classification scheme. Under both definitions for compliance, complete compliers were more likely to exhibit tooth loss than erratic compliers, with the greatest tooth loss exhibited by complete compliers under the definition for compliance 1.

CONCLUSIONS

Based on these results, complete compliers under both definitions tended to show a reduction in plaque and bleeding on probing over time. However, change in periodontal pockets and DMFT over time varied according to the definition of compliance that was used. In addition, the results seem to indicate that the decision for tooth extraction made by dental health professionals at maintenance visits may result in greater tooth loss.

Grindability of cast Ti–Hf alloys

As part of our systematic studies characterizing the properties of titanium alloys, we investigated the grindability of a series of cast Ti-Hf alloys. Alloy buttons with hafnium concentrations up to 40 mass% were made using an argon-arc melting furnace. Each button was cast into a magnesia-based mold using a dental titanium casting machine; three specimens were made for each metal. Prior to testing, the hardened surface layer was removed. The specimens were ground at five different speeds for 1 min at 0.98 N using a carborundum wheel on an electric dental handpiece. Grindability was evaluated as the volume of metal removed per minute (grinding rate) and the volume ratio of metal removed compared to the wheel material lost (grinding ratio). The data were analyzed using ANOVA. A trend of increasing grindability was found with increasing amounts of hafnium, although there was no statistical difference in the grindability with increasing hafnium contents. We also found that hafnium may be used to harden or strengthen titanium without deteriorating the grindability.

Psychological profile in oral lichen planus

AIM

Oral lichen planus (OLP) is an oral lesion with an enigmatic etiology. To explore the possibility of psycho-somatization, we evaluated the psychological personality profiles of OLP patients.

METHODS

Twenty patients with reticular; 20 with erosive form of OLP, and 25 controls were tested with the psychological Minnesota Multiphasic Personality Inventory (MMPI)-202 test. Eight clinical scales (hypochondriasis, depression, hysteria, psychopathic deviate, paranoia, psychasthenia, schizophrenia, and hypomania) as well as cortisol level, CD3, CD4, CD8, and CD16 markers by group were compared. Psychosomatization was evaluated by the use of internalization ratio (IR) Index.

RESULTS

A characteristic MMPI profile was noted in the OLP groups with high IR index value. Significant differences among the groups were detected for cortisol, CD4, CD8, and CD16 counts. Mean values for hypochondriasis, depression, and hysteria were all significantly different with significantly higher mean scores for both reticular and erosive OLP subjects compared with controls.

CONCLUSIONS

Prolonged emotive stress in many OLP patients may lead to psychosomatization and may contribute to the initiation and clinical expression of this oral disorder.

CLINICAL SIGNIFICANCE

If additional research involving a larger and more diverse sample of patients confirms these findings, clinical trials will be needed to determine whether adjunctive psychological intervention provides a benefit in treating patients with OLP.

Evaluation of the safety and efficacy of periodontal applications of a living tissue-engineered human fibroblast-derived dermal substitute. I. Comparison to the gingival autograft: a randomized controlled pilot study

BACKGROUND

Periodontists have found the gingival autograft to be an effective and predictable technique to increase the amount of attached gingiva around teeth, but this technique requires the surgeon to harvest donor tissue from a remote surgical site. The present study seeks to evaluate the safety and effectiveness of a tissue-engineered skin equivalent, a living human fibroblast-derived dermal substitute (HF-DDS), compared to a gingival autograft (GA) consisting of donor tissue harvested from the patient's palate in a procedure designed to increase the amount of keratinized tissue around teeth that do not require root coverage.

METHODS

Twenty-five patients with insufficient attached gingiva associated with at least two teeth in contralateral quadrants of the same jaw were treated. One tooth in each patient was randomized to receive either a GA (control) or a HF-DDS graft (test). Clinical parameters measured at baseline and 3, 5, 7, 9, and 12 months included recession, clinical attachment level, keratinized tissue height, and plaque index. Probing depth was measured at 7, 9, and 12 months. Inflammation of each site was scored and texture and color of the grafted tissue were compared to the surrounding tissue. Resistance to muscle pull was evaluated and a questionnaire was used to determine patient preference. Surgical position of the graft and alveolar bone level were recorded at the surgical visit and patients were evaluated weekly for the first 4 weeks at which time recession and level of oral hygiene were measured. Biopsies and persistence studies were performed on a subset of the patients.

RESULTS

Results for both test and control groups were similar for all measured clinical parameters with the exception of amount of keratinized tissue and percent shrinkage of keratinized tissue. The control group exhibited an average of 1.0 to 1.2 mm more keratinized tissue over time than the test group (P <0.001) and the control group had about half as much shrinkage as the test group over time (P <0.001). Test sites demonstrated significantly better color match over time compared to control sites. Similarly, tissue texture for test sites was significantly better than control sites over time.

CONCLUSIONS

Based on the results of this investigation, the tissue engineered HF-DDS graft was safe and capable of generating keratinized tissue without the morbidity and potential clinical difficulties associated with donor site surgery. The GA generated more keratinized tissue and shrank less than the HF-DDS graft, but the test graft generated tissue that appeared more natural.

Evaluation of the Safety and Efficacy of Periodontal Applications of a Living Tissue-Engineered Human Fibroblast- Derived Dermal Substitute. II. Comparison to the Subepithelial Connective Tissue Graft: A Randomized Controlled Feasibility Study

BACKGROUND

The subepithelial connective tissue graft, traditionally harvested from the patient's palate, is commonly used for root coverage in periodontal recession defects. This study evaluates the safety and effectiveness of a living human fibroblast-derived dermal substitute (HF-DDS) compared to a connective tissue graft (CTG) for root coverage in these situations.

METHODS

Thirteen patients were selected for this study. Each patient had Miller Class I or II bilateral facial recession defects > or =3 mm on two non-adjacent teeth. The test tooth received an HF-DDS graft, while a CTG was placed on the control site. The 10 test surgeries were performed by one operator and three pilot surgeries were performed by another surgeon. Eight of the HF-DDS sites received a single thickness of material; five received a double thickness. Clinical measurements were taken at baseline; 1 week; and 1, 3, and 6 months following surgery. Parameters measured were plaque index, recession depth, clinical attachment levels, recession width, probing depth, and width of keratinized tissue. All clinical readings were taken by a masked, calibrated examiner.

RESULTS

There were no statistically significant differences between the test and control groups. The amount of root coverage was slightly greater for the control group than for the test group, but statistically the difference was insignificant. The width of the recession defect measured at the cemento-enamel junction (CEJ) for the test group was slightly smaller than that of the control group at the conclusion of the study. The amount of keratinized tissue was the same in both groups at 6 months. The probing depth was slightly greater in the control group as was the gain in clinical attachment, but neither was statistically significant. The amount of root coverage obtained when one layer of HF-DDS was used compared to the amount of coverage obtained when two layers were used approached statistical significance, but the small sample size may have been responsible for the difference.

CONCLUSION

Within the limits of this study, the human fibroblast-derived dermal substitute may offer potential as a substitute to the connective tissue graft for covering areas of facial Miller Class I or Class II gingival recession in humans.

Assessment of SS-A and SS-B in parotid saliva of patients with Sjogren's syndrome

BACKGROUND

The purpose of this study was to compare the sensitivity of parotid saliva to that of serum in detecting anti-SSA/Ro and anti-SSB/La autoantibodies in patients with Sjögren's syndrome.

METHODS

Forty patients and 20 controls participated in the study; all patients met the 1993 European Community criteria for the diagnosis of Sjögren's syndrome. Healthy controls were age- and sex-matched individuals with no signs or symptoms of Sjögren's syndrome. Serum and saliva samples were evaluated using AffiniTech SSA/Ro and SSB/La antibodies kits (AffiniTech, Ltd. Bentonville, AR, USA). The results were also compared with serological status of SS-A and SS-B as reported by an independent clinical laboratory.

RESULTS

Serum was significantly more sensitive than saliva in detecting SSA/Ro and SSB/La antibodies (P = 0.001). There was high agreement between the results with the AffiniTech kits and the independent laboratory (kappa = 0.80; P < 0.001). However, there was poor agreement between saliva and serum results (kappa = 0.174; P = 0.168).

CONCLUSIONS

The overall results appear to support that serum analysis is effective method for evaluating the presence of SS-A and SS-B autoantibodies.

Prospective Assessment of the Use of Enamel Matrix Proteins With Minimally Invasive Surgery

BACKGROUND

Minimally invasive surgery (MIS) is a surgical technique using very small incisions, indicated for performing regenerative therapy in periodontal defects. Enamel matrix proteins (EMP) have been shown to enhance periodontal regeneration. This study was undertaken to determine the effect of using EMP in combination with an MIS approach.

METHODS

Patients from two private periodontal practices with chronic periodontitis who, following non-surgical therapy, had one or more sites with probing depths (PD) of > or =6 mm were included in the study. An MIS approach was utilized for surgical access. Following surgical debridement, EMP was placed into the bony defect. The surgical sites were reevaluated after at least 11 months.

RESULTS

Surgical treatment was performed at 160 sites in 16 patients. No significant differences were noted in the results between the two offices and the data were combined. Mean PD reduction (P = 0.002) and attachment level improvements (P = 0.012) were significantly greater than 3 mm with mean post-surgical PD of 3.17 mm and attachment levels of 4.05 mm, based on subject means. Mean change in recession following surgery was negligible (0.01 mm). All sites were considered to be clinically successful.

CONCLUSION

The combination of MIS and EMP yields significant reductions in probing depths and improvements in attachment levels while producing little or no increase in recession.

Stain reduction of an integrated oral hygiene system

This article discusses research to determine the efficacy of a prototype integrated power toothbrush and toothpaste dispensing system, the IntelliClean System from Sonicare and Crest, in the removal of extrinsic stain. The prototype integrated system and a positive control, the Sonicare Elite with conventional toothpaste, were evaluated in 2 randomized, single-blinded, parallel 4-week controlled clinical trials. There was a low dropout rate, with 28 subjects of the 31 randomized in study 1 completing the study (10% loss to follow-up) and 26 subjects of the 28 randomized in study 2 completing the study (7% loss to follow-up). Lobene stain scores were used to assess the extent and intensity of stain for all teeth meeting the criteria for inclusion in the studies. Lobene stain scores were assessed at baseline and after 4 weeks in both studies. A survey also was conducted at the conclusion of each study to determine user attitude toward the integrated system. The prototype integrated system was found to significantly reduce overall extrinsic stain over time, performing not significantly differently from the positive control. Overall, the prototype integrated system reduced the composite measure of stain that encompasses both the extent and intensity of stain by 60%. This research demonstrates that the IntelliClean System from Sonicare and Crest is highly effective in reducing extrinsic stain.

Plaque reduction over time of an integrated oral hygiene system

This article compares the efficacy of a prototype integrated system (the IntelliClean System from Sonicare and Crest) in the reduction of supragingival plaque to that of a manual toothbrush and conventional toothpaste. The integrated system was compared to a manual toothbrush with conventional toothpaste in a randomized, single-blinded, parallel, 4-week, controlled clinical trial with 100 subjects randomized to each treatment group. There was a low dropout rate, with 89 subjects in the manual toothbrush group (11% loss to follow-up) and 93 subjects in the integrated system group (7% loss to follow-up) completing the study. The Turesky modification of the Quigley and Hein Plaque Index was used to assess full-mouth plaque scores for each subject. Prebrushing plaque scores were obtained at baseline and at 4 weeks after 14 to 20 hours of plaque accumulation. A survey also was conducted at the conclusion of the study to determine the attitude toward the two oral hygiene systems. The integrated system was found to significantly reduce overall and interproximal prebrushing plaque scores over 4 weeks, both by 8.6%, demonstrating statistically significant superiority in overall plaque reduction (P = .002) and interproximal plaque reduction (P < .001) compared to the manual toothbrush with conventional toothpaste, which showed no significant reduction in either overall plaque or interproximal plaque. This study demonstrates that the IntelliClean System from Sonicare and Crest is superior to a manual toothbrush with conventional toothpaste in reducing overall plaque and interproximal plaque over time.

Osseointegration of dental implants complexed with rhBMP-2: a comparative histomorphometric and radiographic evaluation

PURPOSE

To evaluate the effect of rhBMP-2 on implant osseointegration using histomorphometric and radiographic imaging analyses and determine the diagnostic accuracy of periapical radiographs regarding clinical bone-implant contact levels.

MATERIALS AND METHODS

Hollow-cylinder implants were filled with an absorbable collagen sponge soaked with recombinant human bone morphogenetic protein-2 (rhBMP-2) or left empty and implanted in the mandibles of dogs. Animals were followed for 2, 4, 8, or 12 weeks. At the end of each time interval, the animals were sacrificed and specimens were collected for histomorphometric and radiographic evaluation of the bone-implant contact levels.

RESULTS

Both groups exhibited the same mean histologic bone-implant contact on the outer surface of the implant, except for the 4-week group. The radiographic evaluation of bone-implant contact overestimated the actual osseointegration levels by at least 30%, a significant amount.

DISCUSSION

The osteoinductive and regenerative potential of rhBMP-2 is of clinical benefit in cases where bone augmentation is indicated and improved levels of osseointegration are expected. Radiographic evaluation has been the most widely employed technique in clinical practice for assessing bone levels around dental implants and comparing changes over time. However, there is a limit to the diagnostic accuracy of conventional radiographs when compared to the data obtained by histologic analysis.

CONCLUSION

Application of rhBMP-2 within the confined boundaries of the hollow chamber of the implant had a limited effect on the osseointegration level along its outer surface, perhaps because of physically restricted diffusion. Radiographic evaluation resulted in the overestimation of bone-implant contact, and poor correlation with the histomorphometric data was found.

A Comparative Study of Coronally Advanced Flaps With and Without the Addition of Enamel Matrix Derivative in the Treatment of Marginal Tissue Recession

BACKGROUND

The primary aim of this randomized, controlled, clinical investigation was to evaluate the differences in clinical parameters of root coverage procedures utilizing coronally advanced flaps (CAF) with and without enamel matrix derivative (EMD). Another aim was to evaluate if EMD can influence keratinization of tissues utilizing these procedures.

METHODS

Fifty-eight contralateral sites in 17 patients with > or = 2 mm of Miller Class I, II, and III buccal marginal tissue recession were treated. Test sites received CAF plus EMD while control sites were treated with CAF only, with each patient serving as his own control. Patients were followed for 3 and 6 months. All data were analyzed using the method of generalized estimating equations. A P value <0.05 was considered significant (alpha = 0.05).

RESULTS

There was a mean increase in keratinized tissue of 0.60 mm for test sites and a mean decrease of 0.05 mm for control sites. Test sites demonstrated significantly better root coverage (P<0.001), 89.7% and 92.9% root coverage after 3 months and 6 months, respectively, while control sites had 56.6% and 66.8% root coverage after 3 months and 6 months, respectively. There was significantly more root coverage among test sites compared to control sites, regardless of arch or Miller classification.

CONCLUSIONS

Based on the results of this study, the application of enamel matrix derivative to denuded root surfaces receiving coronally advanced flaps significantly increased the percentage of root coverage compared to CAF without EMD. In addition, EMD application was accompanied by a significant increase in keratinized tissue 6 months after surgery.

Statherin is an in vivo pellicle constituent: identification and immuno-quantification

Recently, we demonstrated that anti-statherin monoclonal antibodies could be generated upon immunisation of mice with in vivo formed human acquired enamel pellicle, indicating that statherin is a constituent of pellicle. To gain insight in the in vivo adsorption behaviour of statherin we tested the abundance of statherin in pellicle and investigated the relationship between statherin and protein levels in salivary secretions and pellicle using a capture ELISA. Statherin levels were approximately 20-fold higher in parotid and submandibular-sublingual secretions than in cleared whole saliva supernatant or pellicle, suggesting the rapid degradation of statherin in the oral cavity. A strong positive correlation was observed between statherin and protein levels in pellicle but not in saliva indicating that statherin and protein adsorption to pellicle are related processes. This indicates that statherin represents the integral part of proteins that constitute the pellicle structure and may play a key role in its formation.

A Method to Enhance Determining the Clinical Relevance of Periodontal Research Data: Number Needed to Treat (NNT)

It would be advantageous if clinical trials reported both statistical and clinically meaningful results. In this regard, determination of the number of sites that would need to be treated in a test group to provide a beneficial result or prevent an adverse event at one additional site beyond the control group would provide useful information. This editorial addresses the use of NNT (number needed to treat) calculations to enhance determining the clinical relevance of periodontal research findings. The application, requirements for use, benefits, and limitations of employing NNT calculations are discussed.

The Effect of Occlusal Discrepancies on Gingival Width

BACKGROUND

A relationship between occlusal forces and gingival recession has been postulated in the past. However, minimal data are available to demonstrate a causal relationship between occlusal forces and recession.

METHODS

The records from a private practice limited to periodontics were reviewed to find patients who had complete periodontal examination records, including occlusal analysis and gingival width, that were recorded at least 1 year apart. Patients who fit this criteria were divided into those who had none of the recommended treatment (untreated, n = 30), those who had only non-surgical treatment (partially treated, n = 20), and a control group who had completed all recommended surgical and non-surgical treatment (completely treated, n = 41). The data for each tooth of each patient, including occlusal status and gingival width, were placed in a database and analyzed for a relationship between occlusal discrepancies and changes in gingival width.

RESULTS

No statistically significant relationship was detected between the presence of occlusal discrepancies and initial width of the gingival tissue (P = 0.414) or between occlusal treatment and changes in the width of the gingiva (P = 0.481).

CONCLUSION

Based on the current study, there does not appear to be a relationship between occlusal discrepancies and gingival recession.

Patient preference for ultrasonic or hand instruments in periodontal maintenance

The purpose of this study was to determine if patients prefer ultrasonic or hand instruments for periodontal maintenance. A questionnaire of 13 items was answered by 469 patients in three periodontal offices. The results showed a strong preference (74%) for ultrasonic instruments. The possibility of increased compliance because of this preference is discussed.

Crown lengthening in mandibular molars: a 5-year retrospective radiographic analysis

BACKGROUND

Crown lengthening procedures are a significant part of the periodontist's armamentarium. In order to recreate the clinical space lost to caries or trauma necessary for prosthetic restoration, osseous surgery is often required. If the procedure is not carefully planned, it may result in furcation involvement of multirooted teeth.

METHODS

Twenty-six subjects with 26 mandibular molar teeth requiring crown lengthening procedures prior to prosthetic crown placement were evaluated. Nineteen subjects with 24 prosthetic crowns on lower molars which had not undergone crown lengthening were included as control teeth. Bite-wing radiographs prior to surgery (for the test group) or placement of the crown (control group) and 5 years after completion of the prosthesis were compared and analyzed.

RESULTS

Of the 26 test teeth, 10 teeth (38.5%) were found to have radiographic evidence of furcation involvement, whereas none of the control teeth developed furcation invasions.

CONCLUSION

A critical distance from the furcation (CDF) of 4 mm was established as a landmark under which, if surgery was performed on mandibular molars, chances of furcation involvement in the future were very high.

A national survey of the oral health status of homeless veterans

OBJECTIVES

This study reports results from a survey designed to (1) assess the oral health needs of a national sample of homeless veterans and (2) compare the dental needs of homeless veterans participating in VA-sponsored rehabilitation programs with domiciled veterans in VA substance addiction programs.

METHODS

Homeless veterans enrolled in a nationwide rehabilitation program (n = 1,152) completed a survey including questions concerning patients' perceptions of their oral health, dental service needs and use, and alcohol and tobacco use. A sample of these veterans (n = 281) subsequently received dental exams. A comparison group of domiciled veterans enrolled in VA substance abuse programs (n = 339) completed a similar survey. A sample of these veterans (n = 150) also received dental exams.

RESULTS

Sociodemographic variables, patient-reported oral health information and risk behaviors, and findings from dental exams described two remarkably similar populations.

CONCLUSIONS

As expected, the homeless veterans exhibited poor oral health, but it was not different from domiciled veterans enrolled in substance addiction programs. Lifestyle choices, such as heavy drinking and smoking, may contribute more to poor oral health than living conditions.

The prevalence of periodontal-related changes in adolescents with asthma: results of the Third Annual National Health and Nutrition Examination Survey

PURPOSE

The purpose of this study was to explore the association between asthma and periodontal disease in adolescents using oral examination and health interview data from the Third National Health and Nutrition Examination Survey (NHANES III) 1988-1994.

METHODS

The study population comprised 1,596 adolescents 13 to 17 years of age: 253 (16%) asthmatics and 1,358 (84%) nonasthmatic controls who were examined for bleeding on probing (BOP), subgingival calculus (SBC), supragingival calculus (SPC), probing depth greater than or equal to 3 mm (PD), and loss of periodontal attachment greater than or equal to 2 mm (LPA). The authors fitted separate multivariate GEE Poisson regression models adjusting for parents' income, gender, race, exposure to potentially xerogenic drugs (antihistamines, corticosteroids, and inhalers), tobacco exposure, and dental examination within the past year.

RESULTS

None of the periodontal measures was associated with asthma severity or with the use of antiasthmatic drugs. However, several covariates had statistically significant odds ratios (P < .05).

CONCLUSIONS

There was no evidence to support the association between asthma and periodontal health in the adolescent population. Since the findings may be due to the inherent limitations of cross-sectional studies, the lack of knowledge about the daily dose of antiasthmatic medication, and the level of-compliance with the therapeutic regimen, future studies should be longitudinal and monitor medication use.

Increased preventive practices lead to greater tooth retention

Prior research has rarely examined the impact of ADA-recommended preventive practices on tooth retention. We hypothesized that better oral hygiene leads to increased tooth retention. We examined the association of cross-sectional and long-term assessments of preventive practices, as well as various combinations of hygiene practices, with tooth retention. Among 736 male participants in the VA Dental Longitudinal Study, we utilized cross-sectional and longitudinal self-reports of toothbrushing, dental floss use, annual prophylaxis, and combinations of such behaviors, and examined their association with clinically assessed numbers of teeth. Baseline and long-term hygiene behaviors (except brushing) were associated with an increased baseline number of teeth and decreased subsequent tooth loss. Use of multiple hygiene behaviors was associated with greater tooth retention, cross-sectionally and longitudinally. Adherence to ADA recommendations for preventive care leads to better oral health, and consistently practicing preventive behaviors over the long term confers greater benefits than doing so over the short term.

Electrochemical characterization of cast titanium alloys

A reaction layer forms on cast titanium alloy surfaces due to the reaction of the molten metal with the investment. This surface layer may affect the corrosion of the alloy in the oral environment. The objective of this study was to characterize the in vitro corrosion behavior of cast titanium alloys. ASTM Grade 2 CP titanium, Ti-6Al-4V, Ti-6Al-7Nb and Ti-13Nb-13Zr alloys were cast into a MgO-based investment. Experiments were performed on castings (N=4) with three surface conditions: (A) as-cast surface after sandblasting, (B) polished surface after removal of the reaction layer, and (C) sandblasted surface after removal of the reaction layer. Open-circuit potential (OCP) measurement, linear polarization, and potentiodynamic cathodic polarization were performed in aerated (air+10% CO(2)) modified Tani-Zucchi synthetic saliva at 37 degrees C. Potentiodynamic anodic polarization was subsequently conducted in the same medium deaerated with N(2)+10% CO(2) gas 2 h before and during the experiment. Polarization resistance (R(P)) and corrosion rate (I(CORR)) were calculated. Numerical results were subjected to nonparametric statistical analysis at alpha=0.05. The OCP stabilized for all the specimens after 6 x 10(4)s. Apparent differences in anodic polarization were observed among the different surfaces for all the metals. A passivation region followed by breakdown and repassivation were seen on specimens with surfaces A and C. An extensive passive region was observed on all the metals with surface B. The Kruskal-Wallis test showed no significant differences in OCP, R(p), I(CORR) or break down potential for each of the three surfaces among all the metals. The Mann-Whitney test showed significantly lower R(P) and higher I(CORR) values for surface C compared to the other surfaces. Results indicate that the surface condition has more effect on corrosion of these alloys than the surface reaction layer. Within the oxidation potential range of the oral cavity, all the metal/surface combinations examined showed excellent corrosion resistance.

How well prepared are Texas dental hygienists to recognize and report elderly abuse?

The elderly are the nation's fastest-growing population, and the number of elder abuse victims has reached epidemic proportions. In Texas, dentists and dental hygienists are mandated by law to report suspected abuse. This study surveyed Texas dental hygienists regarding elder abuse education received in dental hygiene school and post-graduation. Respondents were also asked to self-assess their knowledge level in recognizing the six types of elder abuse and to answer questions regarding Texas law and mandatory reporting of abuse. A survey designed for this study was mailed to 780 Texas licensed dental hygienists, representing 10 percent of the Texas dental hygiene population. Respondents were selected using a computer-generated random sample. A second mailing was sent to nonrespondents to prevent response bias. Results were analyzed using Statistical Programs for Social Scientists (SPSS). Over one-half of the respondents (56 percent) stated that abuse education was not part of their dental hygiene school curriculum. Only 46 percent of the respondents who replied that abuse education had been included in the curriculum were educated on elder abuse. A majority of respondents stated they lacked knowledge in recognizing the six types of elder abuse, and 81 percent of respondents reported being unknowledgeable about reporting elder abuse. The current status of elder abuse education in dental hygiene programs and post-graduation is insufficient. Dental hygienists have an obligation to become knowledgeable in recognizing and reporting elder abuse in order to provide complete care for their patients.

PMN responses in chronic periodontal disease: evaluation by gingival crevicular fluid enzymes and elastase-alpha-1-proteinase inhibitor complex

OBJECTIVES

In the present trial, the hypothesis was examined that the local PMN responses in untreated and treated chronic periodontitis can be differentiated by gingival crevicular fluid lysosomal enzyme activities and elastase-alpha-1-proteinase inhibitor complex.

METHODS

In nine subjects (average age 49.2 +/- 7.1 years) with chronic periodontitis, clinical parameters and markers of the PMN-derived inflammatory tissue response in gingival crevicular fluid (GCF) were assessed before and 6 months after surgical periodontal therapy. Myeloperoxidase (MPO), beta-N-acetyl-hexosaminidase (beta-NAH) and cathepsin D (CD) were analyzed as indicators of the PMN-associated host tissue destruction, and elastase-alpha-1-proteinase inhibitor complex (alpha-1-EPI) as the major serum protein inactivating PMN elastase. The total activities of the lysosomal enzymes MPO and beta-NAH were evaluated spectrophotometrically, the CD levels by liquid scintillation counting with [14C] hemoglobin as substrate, and the total alpha-1-proteinase inhibitor complex using a sandwich-immunoassay.

RESULTS

The clinical parameters revealed a statistical significant decrease at the 6-month reexamination. PD levels dropped from 5.40 to 2.88 mm (change 2.52 +/- 1.04 mm), the CAL scores from 6.67 to 4.43 mm (change 2.24 +/- 0.77 mm). The 30 s GCF volumes dropped from 129.8 to 68.6, displaying a change of 61.1 +/- 18.6, p </= 0.05. The decrease in total MPO, beta-NAH and CD levels (medians: 1.7/0.6 micro U MPO, 0.035/0.020 micro U beta-NAH, 1.3/0.5 ng CD) following therapy was associated with a significant drop in total GCF amounts of alpha-1-EPI from 76.3 ng at baseline to 52.4 ng after 6 months.

CONCLUSION

The clinical healing in chronic periodontal disease is associated with a downregulation of the local PMN responses following periodontal therapy. The reorganization of periodontal tissues is characterized by a decrease of lysosomal enzyme activities and the alpha-1-proteinase inhibitor complex in gingival crevicular fluid.

Quality of removable partial dentures worn by the adult U.S. population

STATEMENT OF PROBLEMS

Research-based assessments of the quality of removable partial dentures (RPDs), especially within a large patient population, are lacking.

PURPOSE

This study evaluated the prevalence and quality of RPDs by use of the National Health and Nutrition Survey (NHANES III) data set.

MATERIAL AND METHODS

Estimates of the health and nutritional status of the American population were obtained from the NHANES III data set (1988-1994). Calibrated dentists performed dental examinations on 17,884 adults. If the subject wore an RPD, its quality was assessed with 5 criteria: integrity, tooth wear, the presence of temporary reline material or adhesive, stability, and retention. In this study, the data on RPD defects were used to assess the prevalence of problems. The original population was divided into 4 subgroups: paired RPD data = subjects wearing both maxillary and mandibular RPDs (n = 600 prostheses, 300 maxillary and 300 mandibular); single RPD data = subjects with only one RPD (n = 1003 prostheses, 511 maxillary and 492 mandibular); maxillary versus mandibular RPD data = all subjects with all RPDs (n = 1603 prostheses, 811 maxillary and 792 mandibular); and pooled RPD data = all subjects with a single RPD plus subjects with 2 RPDs, counting only the RPD with the most defects (n = 1303 prostheses, 674 maxillary and 629 mandibular). The subjects were analyzed with descriptive statistics. The distribution of defects in the RPDs was examined for possible associations with chi(2) tests. The paired data for patients with both maxillary and mandibular RPDs were analyzed with Wilcoxon signed rank tests. The prevalence of RPDs as a function of patient age and the association between RPD defects and patient age were analyzed with chi(2) tests. The results were considered highly significant at P<.0001 and significant at P<.05.

RESULTS

Of the 17,884 adults who underwent a dental examination, 1306 had RPDs. Three patients were excluded because their records were incomplete, leaving 1303 patients available for analysis. Most of the prostheses examined (65%) had at least 1 defect. Lack of stability was the most prevalent single defect. Distinctions in the type and prevalence of defects were observed between mandibular and maxillary RPDs. Mandibular RPDs had significantly more problems related to retention, whereas maxillary RPDs had significantly more problems related to the presence of reline material and to integrity defects. Tooth wear defects were significantly associated with patient age (P<.0001). Only one third of the RPDs were considered satisfactory according to NHANES III criteria.

CONCLUSION

A review of the database used in this study indicated that, in spite of a decline in tooth loss, RPDs are still used in all age cohorts, including young adults. A large number of RPDs were found to have defects.

Aggressive periodontitis: 5-year follow-up of treatment

BACKGROUND

The hypothesis that in subjects with aggressive periodontitis, a long-term stability of periodontal health can be achieved following comprehensive mechanical/surgical and systemic antimicrobial therapy was tested in this prospective study.

METHODS

Thirteen patients (36.9+/-7.4 years) with aggressive periodontitis were monitored before and up to 5 years following periodontal therapy. Clinical attachment levels (CAL) were assessed pretherapy, and at 3 months following completion of active periodontal therapy supplemented by amoxicillin plus metronidazole. All subjects were subsequently enrolled in a maintenance program and provided with supportive periodontal therapy with 3 to 4 appointments annually. Reexaminations were performed after 6 months and 1, 2, 3, 4, and 5 years. The data were analyzed using the method of generalized estimating equations (GEE) for CAL changes from baseline to the 3-month visit, and from completion of periodontal therapy to each annual visit up to the 5-year follow-up reappointment.

RESULTS

During the 5-year study, all subjects strongly benefited from periodontal treatment. Between baseline and the 3-month reexamination, the CAL levels revealed a significant decrease of 2.23 mm (95% confidence interval [CI]: 1.77 to 2.69 mm; P < or =0.001). At the 5-year maintenance visit, the CAL changes ranged from -0.04 to +0.29 mm with no further statistically significant periodontal breakdown (P >0.05). Five years after surgery, 3.2% of the treated sites demonstrated a further CAL gain > or =3 mm. A stabilization (CAL -2 to +2 mm) occurred in 94.6% of the cases. The number of periodontal sites experiencing a breakdown varied from 5.3% at 6 months to 2.2% at 5 years.

CONCLUSIONS

In aggressive periodontitis, comprehensive mechanical/surgical and antimicrobial therapy is an appropriate treatment regimen for long-term stabilization of periodontal health. In this study, periodontal disease progression was successfully arrested in 95% of the initially compromised lesions, while 2% to 5% experienced discrete or recurrent episodes of loss of periodontal support.

Epidemiologic associations between periodontal disease and chronic obstructive pulmonary disease

The nature of the relationship of periodontal disease to a number of systemic health outcomes, including chronic obstructive pulmonary disease (COPD), remains unclear. Various causal mechanisms have been proposed to explain the observed epidemiologic associations between periodontal diseases and respiratory diseases. We have reviewed the epidemiologic and clinical evidence for this association. The methodologic approach we have taken is based on a structured systematic review of the indexed biomedical literature on these subjects. The primary focus of this review was on the analysis of periodontal health status measures and their association with COPD, which includes chronic bronchitis and emphysema. We found that a paucity of published results exist on this specific relationship and those which do exist typically represent secondary analyses of existing data sets. Nevertheless, the epidemiologic evidence identified in this systematic review indicates that worse periodontal health status is associated with an increased risk of COPD, with odds ratios ranging from 1.45 to 4.50 (significant at the 95% confidence interval). However, it is possible that residual confounding by tobacco smoking may account in part for the observations. A causal association between periodontal health status and risk of COPD, although biologically plausible, remains speculative. Randomized controlled trials will be required in order to address the question of causality and to better understand the biological basis of these epidemiologic associations.

The effect of FIV infection on CD4+ and CD8+ counts in periradicular lesions

AIM

The purpose of this study was to elucidate whether a decrease/increase in T-cell populations is present in the development of periradicular disease in the immunocompromised feline model.

METHODOLOGY

Eight cats were immunosuppressed with steroids prior to infection with feline immunodeficiency virus (FIV). Another eight cats, age and sex matched littermates, were monitored and tested at equivalent periods of time and served as uninoculated, seronegative controls. Periradicular lesions were induced using local bacterial inoculations into the pulp of the canine teeth and assessed after one- and four-week periods, corresponding to the acute and chronic stages of the periradicular disease. Block sections were obtained and specimens were prepared for H & E and immunohistochemical staining for CD4+ and CD8+ receptors. Cells were quantified using a computer imaging system and data analysed using generalized estimating equation (GEE) regression models.

RESULTS

Significantly lower CD4+ counts and CD4+/ CD8+ ratios were observed at all time periods in the periradicular region of the FIV group (P = 0.0006). No significant difference in CD8+ counts was observed between the two groups. In both groups there was a significant difference in the CD4+ counts between one week and baseline, and 1 week and 4 weeks. There was no significant difference between baseline and 4 weeks for either group.

CONCLUSION

FIV infection reflected decreased CD4+ counts at the periradicular level, however, inflammation and progression of the lesion, appeared to be comparable to the non-immunocompromised controls.

Longitudinal comparison of the periodontal status of patients with moderate to severe periodontal disease receiving no treatment, non-surgical treatment, and surgical treatment utilizing individual sites for analysis

BACKGROUND

The progression of periodontal disease without treatment and the response of existing periodontal disease to various types of treatment have been studied extensively. Many past studies have used the mean of the patient's probing depths or attachment levels to evaluate disease progression as opposed to following changes in individual sites or teeth. The purpose of the current study was to evaluate the response of individual teeth to treatment or non-treatment.

METHODS

The records from a private periodontal practice were reviewed to find patients with complete periodontal examinations that were recorded at least 1 year apart. Patients who fit these criteria were divided into those who had none of the recommended treatment (untreated, n = 30); those who had only non-surgical treatment (partially treated, n = 20); and a control group who had completed all recommended treatment (surgically treated, n = 41). The data for each tooth of each patient were placed in a database and analyzed using the method of generalized estimating equations (GEE) to test for associations between increase or decrease in probing depths and various initial clinical parameters while adjusting for significant confounders.

RESULTS

Teeth that received no treatment or non-surgical treatment showed significant increases in probing depths, worsening of prognosis, worsening of furcation involvement, and increases in mobility when compared to surgically treated teeth. Teeth that received surgical treatment showed significant decreases in probing depths. No significant difference was noted between teeth that had no treatment and teeth that had non-surgical treatment.

CONCLUSIONS

When individual teeth are used as the basis for analysis, teeth that receive no treatment or non-surgical treatment show a significant worsening of probing depths, furcations, mobility, and prognosis when compared to teeth that receive surgical treatment, while surgically treated teeth show significant improvement in probing depths.

Career retention in the dental hygiene workforce in Texas

PURPOSE

The purpose of this study was to determine the factors that influence the retention and attrition of dental hygienists within the workforce in Texas. Respondents' perception of the role of employee benefits and practice of dental hygiene on career retention were explored. Demographic descriptors, including educational level, marital status, age, employment setting, and practice statuses, were also examined.

METHODS

A questionnaire modified from the American Dental Hygienists' Association Extension Study: Retention of Dental Hygienists in the Workforce Final Report, April 1992, was mailed to a systematic sample of licensed Texas dental hygienists in March 1999. Descriptive statistics were computed for dental hygienists currently in practice in Texas and those not in practice at the time of the survey. Differences in demographics, benefits, and attitudes between dental hygienists currently in practice in Texas and dental hygienists not in practice at the time of the survey were tested using independent t-tests for interval data and chi-squared tests for categorical data. All statistical analyses were conducted using the Statistical Package for Social Scientists (SPSS v. 9, Chicago, Illinois).

RESULTS

A response rate of 68.1% was obtained. Results revealed the primary reasons for remaining in the practice of dental hygiene were salary, family responsibility, professional collaboration, and variety of work. The primary reasons for leaving dental hygiene practice were family responsibility, boredom, salary, and lack of benefits. Secondary and tertiary reasons stated for staying in clinical practice revealed additional factors including benefits, participation in decision-making, and a safe environment. Dental hygienists in clinical practice were more likely to be employed by a dentist in a single practice and see more patients per day, have a certificate or associate's degree, be unmarried, have fewer children, and be younger than dental hygienists not in practice.

CONCLUSION

The findings suggest that dental hygienists in Texas who remain in the workforce are positively influenced primarily by salary. Dental hygienists in Texas who had left the workforce were primarily influenced to leave practice because of family responsibility. Boredom and lack of benefits were also important factors in deciding to leave clinical practice. Employers of dental hygienists need to be aware of these factors in the hiring process. In addition, dental hygiene educators should prepare students in interviewing techniques for better communication regarding retention factors.

Reproducibility of biopsy grade in Sjögren's syndrome

The purpose of this study was to examine the reproducibility of biopsy grades at various tissue depths in Sjögren's syndrome. The biopsy grades of 38 minor salivary gland biopsies were examined at 6 microm, 50 microm, 100 microm, 150 microm, 200 microm, and 250 microm tissue depths. Tissue sections were stained with routine hematoxylin and eosin, graded I-IV, and compared with the initial "baseline" biopsy grade. The majority of the biopsies showed a wide range of grade variability at all depths. No tissue depth was consistently reproducible for any grade (P> or =0.41, 0.64, 0.91, and 0.20, respectively). The difference between baseline grades and grades of deeper sections was sufficient to impact the diagnosis of Sjögren's syndrome in approximately 60% of the biopsies (P<0.001). The overall result of this study suggests that examination of multiple sections of minor salivary gland biopsies is advisable to improve the reliability of the grade when evaluating Sjögren's syndrome.

Effect of recombinant human bone morphogenetic protein-2 on bone regeneration and osseointegration of dental implants

Recombinant human bone morphogenetic protein-2 (rhBMP-2) induced bone regeneration and osseointegration was evaluated in bony defects created within the hollow chamber of endosseous dental implants in 14 foxhound dogs. Bilateral extractions of mandibular premolars were performed and surgical implantation of 104 hollow cylinder implants followed after 8 weeks of healing. Experimental implants had their hollow chamber filled with 20 microg of rhBMP-2 delivered with a bovine collagen carrier, whereas the control implants had their apical chamber left empty. Dogs were followed for 2, 4, 8 and 12 weeks. Histomorphometric evaluation and immunohistochemical analysis were performed. Minimal bone was regenerated at 2 weeks for both groups. At 4 weeks, bone fill averaged 23.48% for the rhBMP-2 and 5.98% for the control group (P<0.05). At 8 weeks, mean bone fill was 20.94% and 7.75% for the rhBMP-2 and the controls, respectively (P<0.05). At 12 weeks, mean bone fill was 31.39% and 24.31% for the rhBMP-2 and control implants, respectively (P>0.05). Bone-implant contact (BIC) increased for both groups over time and at 8 weeks the rhBMP-2 BIC value was 18.65% and for the control 7.22% (P<0.05). At 12 weeks, the BIC was 43.78% and 21.05% for the rhBMP-2 and the control group, respectively (P<0.05). Immunohistochemical staining for type II collagen was positive only for parts of the collagen carrier and formation of cartilaginous intermediate was not observed in any of the specimens. The results suggest that, in confined defects adjacent to dental implants, rhBMP-2 can induce bone regeneration in close apposition to the implant surface.

The association between asthma and dental caries in children and adolescents: A population-based case-control study

This study explored the potential association between childhood asthma and caries using oral examination and health interview data from the Third National Health and Nutrition Examination Survey 1988-1994 (NHANES III). We fitted GEE Poisson regression models with adjustment for parents' income, gender, race, exposure to potentially xerostomic drugs, and the presence of pit and fissure sealants. There was no association between the use of drugs commonly used by asthmatics (antihistamines, corticosteroids, and antiasthmatic inhalers) and df/DMF scores. Asthmatic children 4-10 years of age at all severity levels had similar dfs scores to the controls, however, severely asthmatic children 4-10 years of age had significantly lower DMFS (p = 0.010) and DMFT (0.049) scores than controls. Similarly, severely asthmatic children 11-16 years of age had significantly lower DMFT scores than controls (p = 0.024) and DMFS scores approaching statistical significance (p = 0.053). While our analysis adjusted for covariates, potential confounders such as fluoride intake from water, diet, use of topical fluorides, and dose of antiasthmatic medication could not be addressed. Our results indicate that any association between asthma and dental caries may occur primarily in younger children with no evidence of an association between asthma and dental caries as children mature.

Outcome of formocresol/ZOE sub-base pulpotomies utilizing alternative radiographic success criteria

PURPOSE

The purposes of this investigation were to 1) measure success of a primary tooth pulpotomy technique that applies formocresol in the sub-base without the common five-minute application of a formocresol impregnated cotton pellet; and 2) compare success rates of the pulpotomy procedure using traditional criteria found throughout the literature with new criteria recently established, excluding internal resorption as a radiographic failure.

METHODS

Clinical and radiographic data were collected from a retrospective chart review of patients receiving formocresol pulpotomies with the application of formocresol in the zinc oxide-eugenol sub-base.

RESULTS

Clinical and radiographic data were available for 196 primary molars in 122 children (followup=six to 103 months; mean=49 months). Traditional assessment of radiographic success and failure yielded a success rate of 79%. Alternative assessment excluding internal resorption as a failure yielded a 99% success rate. Most frequently observed pulpal responses were calcific metamorphosis and internal resorption. Overall clinical success was 99%. Two of the 196 teeth were extracted due to failure. A survival analysis demonstrated that the overall probability of survival remained high over time with a cumulative survival of over 95% after six years.

CONCLUSIONS

The overall success rates in this study indicate that the formocresol pulpotomy technique incorporating formocresol in the zinc oxide-eugenol sub-base is a very successful treatment modality for primary molars requiring pulp therapy.

Feline immunodeficiency virus model to study human immunodeficiency virus/acquired immune deficiency syndrome conditions

This study was designed to induce rapid progression of the feline immunodeficiency virus (FIV) infection in cats. Predictably inducing the FIV disease state in the cat would yield an excellent tool to study endodontic disease processes under immunosuppressed conditions. Eight cats were immunosuppressed with steroids before infection with FIV. Another eight cats, age- and sex-matched littermates, served as uninoculated seronegative controls. Complete blood counts were taken for 10 mo in the FIV group, and 10 wk in the control group, including lymphocyte subsets. ELISAs were used to detect FIV infection. Statistical analysis was performed with generalized estimating equation models. All cats were positive at one point in time. The FIV group had significantly lower peripheral blood CD4+ counts compared with the control group. Therefore the FIV model presented gives the desired outcome and simulates what occurs in human immunodeficiency virus infection.

Alternative method of hemorrhage control in full strength formocresol pulpotomy

PURPOSE

This investigation evaluated the success of a formocresol pulpotomy technique in which hemostasis was obtained with the same formocresol dampened cotton pellet used to medicate the root pulp stumps and to compare the findings of this investigation with data of published formocresol pulpotomy studies in which hemorrhage was controlled by traditional means.

METHODS

Clinical and radiographic data were available for 194 primary molars in 112 patients with follow up times ranging from 5 to 109 months (mean = 38 months).

RESULTS

Overall radiographic success was 87%. The most frequently observed pulpal responses were calcific metamorphosis (34%) and internal resorption (10%). Overall clinical success was 98%. Only 7 of 194 molars were extracted due to radiographic and/or clinical failure. Overall cumulative probability of survival remained high over time with a cumulative survival rate of over 94% over 4 years.

CONCLUSIONS

The success rates for this variation of the formocresol technique are comparable to those success rates in the literature where hemostasis was obtained in a separate step using a nonmedicated cotton pellet. The results of this study suggest that using the same cotton pellet dampened with full strength formocresol to obtain hemorrhage control and medicate the root pulp is an acceptable variation of the traditional formocresol pulpotomy technique.

Porcelain adherence to dental cast CP titanium: effects of surface modifications

OBJECTIVES

A reaction layer forms on cast titanium surfaces due to the reaction of the molten titanium with the investment material. Such a layer prevents strong adhesion between titanium and porcelain. This study characterized the effects of surface modifications on cast titanium surfaces and titanium-ceramic adhesion.

METHODS

ASTM grade II CP titanium was cast into an MgO-based mold. Castings were devested by sandblasting with alumina particles, and subjected to surface modification by immersion in one of the following solutions: (1) 35% HNO3-5% HF at room temperature for 1min; (2) 50% NaOH-10% CuSO4 x 5H2O at 105 degreesC for 10min; (3) the NaOH-CuSO4 solution followed by the HNO3-HF solution; (4) 50% NaOH-10% NaSO4 at 105 degreesC for 10 min; (5) the NaOH-NaSO4 solution followed by the HNO3-HF solution; and (6) 50% NaOH solution at 105 degreesC for 10min. Surfaces only sandblasted with alumina were used as controls. Specimen surfaces were characterized by XRD and SEM/EDS, and hardness-depth profiles were determined. All specimens were sandblasted with 110 microm alumina particles before porcelain firing. An ultra-low-fusing porcelain (Vita Titankeramik) was fused on the titanium surfaces. The titanium-ceramic adhesion was characterized by a biaxial flexure test, and area fraction of adherent porcelain (AFAP) was determined by X-ray spectroscopy.

RESULTS

EDS analyses revealed a substantial amount (13-17 wt%) of Al on the control, and specimens modified with Methods 2, 4, and 6. XRD revealed residual stress in the titanium surfaces and corundum on the control, and Methods 2, 4, and 6 specimens. A new Ti(Cu, Al)2 phase was identified on the titanium surfaces modified by immersion in 50% NaOH-10% CuSO4 x 5H2O aqueous solution. Reduced residual stress was observed on Method 1, 3, and 5 specimens. No corundum peaks were detected on these specimens. Compared to the control, significantly lower (P < 0.05) hardness values were found for Methods 1-3 and Method 5 specimens at 20 microm below the surfaces and for Method 1-5 specimens at 50 microm below the surfaces. Significantly higher (P < 0.05) AFAP values were found for surfaces modified with Methods 2-6 compared to the control and Method 1, and no significant differences were found among Methods 1-6, and between control and Method 1.

SIGNIFICANCE

Based on the results from the present study, porcelain adherence to cast CP titanium can be improved by the caustic baths used in the study.

Accuracy of mandibular cross-sectional imaging with tuned- aperture computed tomography (TACT), iteratively reconstructed TACT, and multidirectional, linear, and transverse panoramic tomography

OBJECTIVE

This study was designed to compare 5 modalities with respect to accuracy in mandibular cross-sectional imaging. The modalities tested were tuned-aperture computed tomography (TACT), iteratively reconstructed TACT, multidirectional tomography, linear tomography, and transverse panoramic tomography.

STUDY DESIGN

Twenty sites were selected from 3 dry human mandibles, and cross-sectional views were imaged through use of each of the 5 modalities. A quantitative analysis included measurements of 2 linear distances; a qualitative study included image evaluation by 6 observers. A nested mixed analysis of variance model was used to control for mandibles and locations within mandibles for the quantitative analysis; the Cochran-Mantel-Haenszel test was used for the qualitative analysis.

RESULTS

There was a significant difference in measurement error for maximum height but not for width. There was also a significant difference in qualitative image evaluation results.

CONCLUSIONS

Of the 5 modalities tested, the narrow-layer multidirectional tomographic technique produced the greatest diagnostic accuracy and quality in cross-sectional imaging. The transverse panoramic tomographic technique produced the least diagnostic accuracy and quality. Linear tomography, TACT, and iteratively reconstructed TACT were intermediate in accuracy and quality.

The effect of occlusal discrepancies on periodontitis. II. Relationship of occlusal treatment to the progression of periodontal disease

BACKGROUND

A causal relationship between occlusal discrepancies and periodontal disease has been postulated in the past. However, minimal data are available concerning the effect of treatment of occlusal discrepancies on periodontitis.

METHODS

The records from a private practice limited to periodontics were reviewed to find patients who had complete periodontal examination records, including occlusal analysis, that were recorded at least 1 year apart. Patients who fit these criteria were divided into a group that had none of the recommended treatment (untreated n = 30), those who had only non-surgical treatment (partially treated n = 18), and a control group that had completed all recommended treatment (surgically treated n = 41). The data for each tooth of each patient, including occlusal status, were placed in a database and analyzed using the generalized estimating equations method.

RESULTS

Worsening in overall clinical condition, as measured by worsening in prognosis, indicated that teeth with no initial occlusal discrepancies and teeth with treated initial occlusal discrepancies were only about 60% as likely to worsen in overall clinical condition over time compared to teeth with untreated occlusal discrepancies. Teeth with untreated occlusal discrepancies were also shown to have a significantly greater increase in probing depth per year than either teeth without initial occlusal discrepancies or teeth with treated initial occlusal discrepancies (P < 0.001). In addition, teeth with untreated occlusal discrepancies had a significant increase in probing depth per year (P < 0.001), whereas teeth without initial occlusal discrepancies and teeth with treated initial occlusal discrepancies had no significant increase in probing depth per year (P > 0.05).

CONCLUSIONS

This study provides strong evidence of an association between untreated occlusal discrepancies and the progression of periodontal disease. In addition, this study shows that occlusal treatment significantly reduces the progression of periodontal disease over time and can be an important adjunct therapy in the comprehensive treatment of periodontal disease.

The effect of occlusal discrepancies on periodontitis. I. Relationship of initial occlusal discrepancies to initial clinical parameters

BACKGROUND

A causal relationship between occlusal discrepancies and periodontal disease has been postulated in the past. However, animal studies and clinical studies have not been able to clearly demonstrate or rule out this potential relationship.

METHODS

The records from a private practice limited to periodontics were reviewed to find patients who had complete periodontal examination records, including occlusal analysis, that were recorded at least 1 year apart. Patients who fit these criteria were divided into a group who had none of the recommended treatment (untreated n = 30), those that had only nonsurgical treatment (partially treated n = 18), and a control group that had complete all recommended treatment (surgically treated n = 41). The data for each tooth of each patient, including occlusal status, were placed in a database and analyzed using the generalized estimating equations (GEE) method to test for associations between initial occlusal discrepancies and various initial clinical parameters while adjusting for significant confounders.

RESULTS

Teeth with initial occlusal discrepancies were found to have significantly deeper initial probing depths (P < 0.0001), significantly worse prognoses (P < 0.0001), and significantly worse mobility than teeth without initial occlusal discrepancies. In addition, this association between initial occlusal discrepancies and initial periodontal condition was found to hold for various subsets considered as well, including posterior teeth only and when only patients with good oral hygiene were considered.

CONCLUSIONS

This study indicates that there is a strong association between initial occlusal discrepancies and various clinical parameters indicative of periodontal disease. Based on adjustments made for other known risk factors for periodontal disease, such as smoking, poor oral hygiene, etc., this study provides some evidence that occlusal discrepancy is an independent risk factor contributing to periodontal disease.

Restoring teeth that are endodontically treated through existing crowns. Part I: Survey of pulpal status on access

OBJECTIVE

The purpose of this study was to identify the pulpal findings encountered by practitioners when accessing complete-coverage crowns that require nonsurgical root canal treatment and the relevance of coronal leakage to the success of the RTC.

METHOD AND MATERIALS

The survey package consisted of a cover letter stating the instructions, rationale, and purpose for the questionnaire, a questionnaire with 8 short-answer questions, and a stamped, self-addressed envelope. A randomized sample of active dentists (300 general practitioners, 300 prosthodontists, and 300 endodontists) was selected. Collected data were analyzed with the chi-square test.

RESULTS

A 60% response rate was obtained. Statistically significant differences were found among the practitioner groups, depending on the question. General practitioners and endodontists obtain access through crowns and maintain these crowns as final restoration significantly more often than do prosthodontists. Practitioners responded that teeth with complete crowns require nonsurgical root canal treatment after 5 to 10 years.

CONCLUSION

Respondents believe that leakage must be addressed when endodontic access cavities in artificial crowns are restored after nonsurgical root canal treatment. General practitioners perform nonsurgical root canal treatment more frequently than do prosthodontists. Practitioners indicated that when teeth with complete crowns require nonsurgical root canal treatment, treatment is most often performed 5 to 10 years after placement of the crown.

Restoring teeth that are endodontically treated through existing crowns. Part II: Survey of restorative materials commonly used

OBJECTIVE

A survey was undertaken to categorize the materials used for the restoration of endodontic access openings through complete-coverage crowns after completion of nonsurgical root canal treatment.

METHOD AND MATERIALS

The survey package consisted of a cover letter stating instructions, rationale, and purpose for the questionnaire, a questionnaire of 8 short-answer questions, and a stamped, self-addressed envelope. A randomized sample of active dentists (300 general practitioners, 300 prosthodontists, and 300 endodontists), was selected. Collected data were analyzed with the chi-square analysis.

RESULTS

Most general practitioners (93%), endodontists (61%), and prosthodontists (75%) reported that they frequently or always permanently restore teeth after nonsurgical root canal treatment. Empress was the all-ceramic system used most commonly by prosthodontists (42%) and general practitioners (38%). A statistically significant difference in restorative material preference was found (P < 0.0001), depending on the type of crown used.

CONCLUSION

Amalgam alone and in combination with bonding agents are materials of choice for restoration of access openings through all-metal complete crowns, while resin composite is the choice for all types of complete crowns involving porcelain. Endodontists preferred "other" materials.

Ferric sulfate pulpotomy in primary molars: a retrospective study

PURPOSE

This investigation collected clinical and radiographic data from a retrospective chart review of patients receiving ferric sulfate pulpotomies with a sub-base of zinc oxide eugenol in a clinical practice over a five-year period.

METHODS AND MATERIALS

Clinical and radiographic data were available for 242 primary molars in 171 children with follow-up times ranging from 4-57 mos (mean = 19 mos).

RESULTS

The overall radiographic success rate ranged from 74-80%. The frequency of normal appearing pulps decreased over time. The most frequently observed pulpal responses were calcific metamorphosis (6-33%) and internal resorption (7-18%). Overall clinical success was 99%. Only 9 of the 242 teeth were extracted due to radiographic and/or clinical failure. A survival analysis demonstrated that the overall cumulative probability of survival remained high over time with a cumulative survival of over 90% after 3 years.

CONCLUSIONS

The overall success rates in this study are lower than those reported previously in the literature for ferric sulfate pulpotomies, but are comparable with those reported for 1:5 dilution, 5-min formocresol pulpotomies.

Long-term results of a minimally invasive surgical approach for bone grafting

A retrospective analysis of the results obtained from regenerative surgery performed utilizing a minimally invasive surgical approach was performed. Bone grafting procedures were performed at 194 sites in 87 patients using small incisions and minimal flap reflection. There were 44 females with a mean age of 52.7 years and 43 males with a mean age of 54.9 years. The mean healing time at which data were collected was 21.7 months. Postsurgical data were collected at the time of routinely scheduled supportive periodontal therapy (SPT) appointments by 2 evaluators. Mean changes in probing depth and attachment levels were evaluated utilizing a Wilcoxon sign rank test. Mean improvement in probing depth was 4.58 mm (P <0.0001) and attachment level was 4.87 mm (P <0.0001). These improvements were seen for all levels of initial prognosis (good to poor) and appeared to be stable over time. The postsurgical gingival margin was at or within 1 mm of the cemento-enamel junction (CEJ) for 58% of the sites treated. This was interpreted to indicate good retention of soft tissue height postsurgically. It was concluded that the minimally invasive approach for bone grafting yielded results that were equivalent to more traditional surgical approaches utilizing longer incisions and greater reflection.